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Leg ulcer

Daniel Pollack
A 55-year-old man with poliomyelitis presented with a plantarflexed foot and painful ulceration of the sub-first metatarsophalangeal joint present for many years. A two-stage procedure was performed to bring the foot to 90°, perpendicular to the leg, and resolve the ulceration. The first stage corrected only soft-tissue components. It involved using a hydrosurgery system to debride and prepare the ulcer, a unilobed rotational skin plasty to close the ulcer, and a tendo Achillis lengthening to decrease forefoot pressure...
January 2018: Journal of the American Podiatric Medical Association
Rafael García Carretero, Maria Garrido-Ollero, Ana Martinez-Alvarez, Ana Cadenas-Vara
Chronic leg ulcers can have a major impact on the quality of life of patients. These wounds can be complex and hard to heal, as several factors may affect the outcome. Underlying conditions, bacterial growth and excess moisture may prevent wounds from healing. We describe the case of a patient with known chronic venous disease, who was admitted to our hospital for several complex, irregular and infected chronic venous ulcers in his lower legs. The management was frustrating for several months, until we began to use methacrylate powder dressing for his hard-to-heal wounds...
March 15, 2018: BMJ Case Reports
Kathleen J Finlayson, Christina N Parker, Charne Miller, Michelle Gibb, Suzanne Kapp, Rajna Ogrin, Jacinta Anderson, Kerrie Coleman, Dianne Smith, Helen E Edwards
The aim of this study was to validate a newly developed tool for predicting the risk of recurrence within 12 months of a venous leg ulcer healing. Performance of the tool to predict recurrence within a 12-month period was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Multi-site retrospective and prospective longitudinal studies were undertaken to validate a risk assessment tool for the recurrence of venous leg ulcers within 12 months. In the retrospective study (n = 250), 55% of venous leg ulcers recurred within 12 months, and the risk assessment total score had excellent discrimination and goodness of fit with an AUC of 0...
March 13, 2018: International Wound Journal
Hallie E Baer-Bositis, Taylor D Hicks, Georges M Haidar, Matthew J Sideman, Lori L Pounds, Mark G Davies
OBJECTIVE: Tibial interventions for critical limb ischemia are now commonplace. Restenosis and occlusion remain barriers to durability after intervention. The aim of this study was to examine the patient-centered outcomes of open and endovascular reintervention for symptomatic recurrent disease after a primary isolated tibial endovascular intervention. METHODS: A database of patients undergoing isolated primary lower extremity tibial endovascular interventions between 2006 and 2016 was retrospectively queried...
March 8, 2018: Journal of Vascular Surgery
B Heringstad, C Egger-Danner, N Charfeddine, J E Pryce, K F Stock, J Kofler, A M Sogstad, M Holzhauer, A Fiedler, K Müller, P Nielsen, G Thomas, N Gengler, G de Jong, C Ødegård, F Malchiodi, F Miglior, M Alsaaod, J B Cole
Routine recording of claw health status at claw trimming of dairy cattle has been established in several countries, providing valuable data for genetic evaluation. In this review, we examine issues related to genetic evaluation of claw health; discuss data sources, trait definitions, and data validation procedures; and present a review of genetic parameters, possible indicator traits, and status of genetic and genomic evaluations for claw disorders. Different sources of data and traits can be used to describe claw health...
March 7, 2018: Journal of Dairy Science
Mazlum Sahin, Helin El
AIM: To evaluate the accuracy of the FARP2 scoring system in predicting early graft failure after infrainguinal bypass surgery (IBS). METHODS: Patient charts which underwent IBS between January 2014 and January 2017 , in two tertiary academic centers were evaluated retrospectively. In follow ups, one week after operation, detailed physical examination was done and doppler ultrasonography was performed one month after operation and integrity of the graft was evaluated...
March 6, 2018: Annals of Vascular Surgery
Alan S Boyd
This report describes the presence of cutaneous nodules and ulceration of the right leg of 1-year duration in an elderly woman. Prior biopsies had demonstrated dermal and subcutaneous granulomatous inflammation. Special stains for microorganisms and cultures were repeatedly negative. Polymerase chain reaction evaluation of the tissue block demonstrated the presence of Mycobacterium obuense.
January 2018: International Journal of Mycobacteriology
Nicolas Cerusico, Juan P Aybar, Silvana Lopez, Silvia G Molina, Romina Chavez Jara, Maria Eugenia Sesto Cabral, Juan C Valdez, Aida Ben Altabef, Alberto N Ramos
Chronic venous leg ulcer (CVLU) arises as a chronic venous insufficiency complication and is a major cause of morbidity throughout the world. Our hypothesis is that the CVLU exudate composition is a biochemical representation of the wound clinical state. Then, Fourier Transform Infrared (FTIR) spectroscopy could be a useful and less-invasive technique to study the clinical state of the ulcer. For this, the aim of this work was to perform a spectral characterization of the exudate from CVLU using FTIR spectroscopy to identify potential healing markers...
March 7, 2018: Analyst
Stefan Walzer, Daniel Dröschel, Lutz Vollmer, Leanne Atkin, Karen Ousey
OBJECTIVE: Venous leg ulcers (VLUs) cause significant pain and suffering for patients. Additionally, they place considerable financial and service burden on the National Health Service (NHS). A large proportion of VLUs do not heal within the standard time frame of 16-24 weeks, resulting in static wounds which commonly have issues with increasing exudate production. As the NHS continues to face times of austerity, services need to find solutions to be able to reduce costs and release nursing time while maintaining standards of care...
March 2, 2018: Journal of Wound Care
David Russell, Leanne Atkin, April Betts, Caroline Dowsett, Francis Fatoye, Sarah Gardner, Julie Green, Chris Manu, Tracey McKenzie, Helena Meally, Louise Mitchell, Julie Mullings, Isaac Odeyemi, Andrew Sharpe, Gillian Yeowell, Nancy Devlin
OBJECTIVE: Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing...
March 2, 2018: Journal of Wound Care
Flora N Balieva, Andrew Y Finlay, Jörg Kupfer, Lucía Tomas Aragones, Lars Lien, Uwe Gieler, Françoise Poot, Gregor B E Jemec, Laurent Misery, Lajos Kemeny, Francesca Sampogna, Henriët van Middendorp, Jon Anders Halvorsen, Thomas Ternowitz, Jacek C Szepietowski, Nikolay Potekaev, Servando E Marron, Ilknur K Altunay, Sam S Salek, Florence J Dalgard
Skin disease and its therapy affect health-related quality of life (HRQoL). The aim of this study was to measure the burden caused by dermatological therapy in 3,846 patients from 13 European countries. Adult outpatients completed questionnaires, including the Dermatology Life Quality Index (DLQI), which has a therapy impact question. Therapy issues were reported by a majority of patients with atopic dermatitis (63.4%), psoriasis (60.7%), prurigo (54.4%), hidradenitis suppurativa (54.3%) and blistering conditions (53%)...
March 2, 2018: Acta Dermato-venereologica
Fedor Lurie, Samir Bittar, Gregory Kasper
Venous leg ulcers remain a major public health issue with significant economic impact. Two main components of the management of patients with venous leg ulcers are compression therapy and wound care. This article addresses principles and specific aspects of compression therapy and focal wound care for patients with venous leg ulcers.
April 2018: Surgical Clinics of North America
Joseph D Raffetto
Chronic venous disease and venous leg ulceration are a common disease affecting millions of individuals. The fundamental problem is venous hypertension with resultant clinical manifestations of venous disease including varicose veins, skin changes, and venous leg ulceration. The pathophysiology leading to venous hypertension is complex and multifactorial, involving genetic predisposition, environmental factors, hormones, endothelial dysfunction, inflammatory cells and molecules and activation on the endothelium and vein wall, and disturbances in the balance of cytokines and matrix metalloproteinases...
April 2018: Surgical Clinics of North America
Øyvind Heiberg Sundby, Ingebjørg Irgens, Lars Øivind Høiseth, Iacob Mathiesen, Eivind Lundgaard, Hanne Haugland, Harald Weedon-Fekjær, Jon O Sundhagen, Gunnar Sandbæk, Jonny Hisdal
STUDY DESIGN: Randomized, assessor-blinded crossover pilot study. OBJECTIVES: To explore the use of an intermittent negative pressure (INP) device for home use in addition to standard wound care (SWC) for patients with spinal cord injury (SCI) and chronic leg and foot ulcers before conducting a superiority trial. SETTING: Patient homes and outpatient clinic. METHODS: A 16-week crossover trial on 9 SCI patients (median age: 57 years, interquartile range [IQR] 52-66), with leg ulcers for 52 of weeks (IQR: 12-82) duration...
March 1, 2018: Spinal Cord
Sandra Assis, Charlotte Yvette Henderson, Sílvia Casimiro, Francisca Alves Cardoso
Differential diagnosis is a fundamental step in every palaeopathological study. It is a challenging exercise since many intrinsic and extrinsic factors may negatively impact the accurate interpretation of bone changes in human skeletal remains. Among these, the completeness and preservation of skeletal elements plays a significant role. This study aims to explore the limits of differential diagnosis in the analysis of disarticulated, fragmented bones. The sample consists of twelve adult bone fragments with noticeable changes...
March 2018: International Journal of Paleopathology
Peter Vowden, Kath Vowden
Recent health economic publications have highlighted the cost of wound care and demonstrated the important role played by community and practice nurses in delivering care. Leg ulcers form a significant proportion of the wounds managed in the community. Data indicates that many patients are managed with no specific diagnosis or without calculation of the ankle brachial pressure index (ABPI), despite care guidelines emphasising the importance of a full assessment including Doppler ABPI calculation in patient management...
March 2, 2018: British Journal of Community Nursing
Julie Green, Rebecca Jester, Robert McKinley, Alison Pooler
This article, the first of two, summarises a study that explored the lived experiences of patients with leg ulcers and the impact of this condition on their quality of life. The study had four study phases; phases 1 and 2 employed qualitative methods and are reported here. Initially, unstructured interviews were held; these revealed significant issues for the patients including the dominance of pain, issues relating to exudate and odour, social isolation and psychological effects. A checklist based on these issues was completed by the researcher during observations of routine care for these same patients; this revealed the extent and depth to which these matters were addressed...
March 2, 2018: British Journal of Community Nursing
Leelavathy Budamakuntla, Eswari Loganathan, Sacchidananda A Sarvajnamurthy, H V Nataraj
Introduction and Objectives: The restoration of the epithelium after injury takes place by migration of epithelial cells adjoining a wound or by centrifugal migration from hair follicles. To evaluate the feasibility and potential healing capacity of scalp follicular unit grafts transplanted into the wound bed of chronic leg ulcers. Materials and Methods: Patients with chronic nonhealing ulcers of more than 6 weeks duration were selected for the study. Those with infected ulcers and uncontrolled diabetes were excluded from the study...
October 2017: Journal of Cutaneous and Aesthetic Surgery
Uwe Wollina, Birgit Heinig, Christian Stelzner, Gesina Hansel, Jacqueline Schönlebe, Georgi Tchernev, Torello Lotti
BACKGROUND: Leg ulcers are a burden to patients, their families and society. The second most common cause of chronic leg ulcers is the mixed arterio-venous type. An 80-year-old female patient presented to our department due to painful enlarging chronic leg ulcer of mixed arteriovenous origin on her left lower leg. She suffered from peripheral arterial occlusive disease stage I and chronic venous insufficiency Widmer grade IIIa, and a number of comorbidities. AIM: The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency...
January 25, 2018: Open Access Macedonian Journal of Medical Sciences
Andre S A Bowers, Walworth W Duncan, D J Pepple
Background  There is no consensus regarding the role of red blood cell (RBC) aggregation in the pathogenesis of leg ulcers (LUs) in sickle cell disease (SCD). Objectives  We sought to evaluate whether the cross-sectional determination of RBC aggregation and hematological indices were associated with the presence of LU in homozygous SCD. Methods  Twenty-seven patients with LU and 23 with no history of ulceration were recruited into the study. A laser-assisted rotational red cell analyzer (LoRRca) was used in the determination of the aggregation index (AI), aggregation half-time ( t 1/2 ), and the RBC aggregate strength (AMP)...
March 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
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